Polyurethane Implants in 2-Stage Breast Reconstruction: 9-Year Clinical Experience.

BACKGROUND: Capsular contracture (CC) is a major complication of breast surgery with smooth and textured implants. Polyurethane (PU) foam-coated breast implants were developed to decrease the incidence of CC. OBJECTIVES: The authors determined the incidence of CC following 2-stage breast reconstruction using PU foam-covered implants, with and without radiation therapy. METHODS: The records of 92 patients who received 115 PU implants were retrospectively reviewed. The rates of CC over time were compared for irradiated and nonirradiated groups with a Kaplan-Meier analysis and log-rank test. CC rates also were analyzed with respect to age. RESULTS: The median follow-up time for patients was 103.3 months. Nine patients experienced unilateral Baker grade III or IV fibrous CC, including 6 patients from the irradiated group and 3 patients from the nonirradiated group. The overall cumulative incidence of CC at 9 years was 8.1%. In the irradiated and nonirradiated groups, the 9-year cumulative incidence was 10.7% and 5.5%, respectively. CC occurred within 3 years in the irradiated group and within 7 years in the nonirradiated group. The incidence of CC appeared to be higher among younger patients. CONCLUSIONS: Radiation therapy increases the risk of high-grade CC with textured or smooth implants. PU implants are associated with a much lower cumulative incidence of CC following 2-stage breast reconstruction, even when radiotherapy is performed. LEVEL OF EVIDENCE 3.

Lipostructure technique in Romberg syndrome.

Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is an uncommon degenerative and poorly understood condition. It is characterized by a slow and progressive atrophy affecting one side of the face. The incidence and the cause of this alteration are unknown. Pathogenesis of this syndrome is not clear: some authors refer the atrophy of subcutaneous system to the alteration of sympathetic system, whereas others refer it to an alteration of the nervous system referred to the encephalic level or to an interstitial neuritis of the trigeminal nerve. The most common complications that appear in association to this health disorder are as follows: trigeminal neuritis, facial, and epilepsy, the last one being the most frequent complication of the central nervous system. Characteristically, the atrophy progresses slowly for several years, and soon after, it becomes stable. Today, plastic surgery with graft of autogenous fat can be performed after stabilization of the disease. The objective of this work is, through the presentation of a clinical case, suggesting a therapeutic plan formed by 2 sequential treatments: poliglactic acid to obtain skin thickening followed by Coleman technique for reconstructing three-dimensional projection of face contour restoring the superficial density of facial tissues. The results we obtained prove the efficacy of combining these 2 treatments, and the satisfaction of the patient confirms the quality of our results.